If your brain is dead, having someone shove a tube down your throat to keep
you alive with some concoction pumping into your stomach, I would imagine
that to be a far worse pain for both self and loved ones, than the
alternative, a gentler more natural passing.   If your brain is dead, what
is the purpose of keeping the body alive?

Everyone will eventually have to die, even you and me, and everything that
is born eventually dies.   Shouldn't it be as natural and as painless as
possible.   I have a living will and I expressly have forbidden feeding
tubes etc.

Pain medications I absolutely would NOT forbid, even though it may shorten
the length of ones life.   There is no reason I can think of to go out in
that much pain, or to prolong the agony by denying pain meds.

Your own values or religious beliefs may vary from that of course, but most
people don't want to prolong life artificially with a feeding tube when the
mind is so far gone they cannot even eat anymore.

The purpose of life is to experience and to give as much peace and comfort
and joy as we can in it.   When all of that is totally gone never to return,
it would be CRUEL to continue with a feeding tube.  Just my humble opinion.

Both my mother and my younger sister had to have "feeding tubes".  Both were
conscious at the time, and the tubes were inserted directly into their
stomachs rather than down their throats.  I am no expert on the matter, but
I had always believed that it was only breathing tubes that were intubated
in the throat.  Nutrition is supplied intravenously, and directly to the
stomach.  I cannot imagine a conscious person having to have food delivered
by a tube in the throat.  In any case, I would also think that withholding
food from an unconscious person would *not* cause pain.  This is certainly a
question for your mom's doctor.  At her age and in her condition, I would
hope she has a geriatric specialist.  If not, please make plans to visit one
right away.  Also keep in  mind that any condition (withholding or
permitting feeding) is up to her.  A living will does not designate one way
another until it is decided upon by the individual.  She should do it now
before she is totally incompetent.  BTW, legal competence is defined much
more broadly than we would apply the term socially and medically.

Dennis White

Presumably not.  This was one of the considerations I made when my 59
y.o. Dad was on his final exit.  Probably one of the most painful
decisions I've made in my life.  In the final days, there are several
levels of care--I opted for 'comfort' which was simply fluid for
hydration (a glucose drip) (we didn't have a living will but I held
medical power of attorney).  To this date, I'm convinced that this
'comfort' measure addressed *my* needs.

They're the greatest group of people that I've never met.

Darryl.

The question of feeding tubes is a complicated one, since all of us
have an emotional reaction to the idea of "letting someone starve". We
think a feeding tube will help our loved one, keep them healthier and
alive longer, let them be more comfortable etc.

When you stand back - there is quite a body of research that suggests
that feeding tubes accomplish none of these things for people in late
dementia.

Research strongly suggests that tube feeding in patients with
late-stage dementia results in:
• Either no change or an increase in the rate of aspiration and
pneumonia (and this is even true of the PEG tubes)
• No improvement in survival
• Little or no improvement in weight loss or other nutritional
parameters.
• No reduction in the incidence of pressure sores, and little or no
effect on healing of established sores.
• An increase in the use of physical and chemical restraints
• Major and minor complications, such as tube obstruction and
dislodgment, local and systemic infection, bowel perforation, and
death

So.... when a procedure has no benefits or is harmful, I think most of
us would wonder ethically why it you'd even go there - I can't see any
positives in it. I can see contemplating a tube if the person was in
early dementia with good quality of life, and would only need a tube
temporarily (i.e. had some temporary illness, and would recover and
not need a tube after a short while). Thats just not true of later
stage AD.

We elected not to go for tubes and IVs with my MIL, and as I've
related here before, she did not seem to be suffering at all. I expect
its just part of the natural process of dying - she did not seem to be
at all hungry or thirsty, and she gradually ate and drank less and
less until she stopped entirely, despite lots of prompting and
encouragement, and being offered it many, many times a day. She just
had no interest - or maybe she didn't even have enough conscious
thought left to interpret physical feelings or know what food or drink
was.

We kept her very comfortable. She was not in any pain. She just sort
of slowly and peacefully slid away over a period of a couple of weeks.
Now, it is hard to watch and do nothing, since particularly in western
culture, we have such a hard time coping with death, and accepting
that its part of life and inevitable and not always a Bad Thing. We
get in our heads that we should fight it to the end, and always be
DOING something, rather than sitting quietly, holding their hand, and
letting the tide go quietly out.  Fighting death in a person with end
stage AD is more about our own fears and guilt than it is about what
is kindest and most loving for the person who's dying. I mean, we've
all seen it - elderly sick loved ones for whom there is no chance of
meaningful recovery, and instead of their last days being quiet and
loving, they are in some horrible impersonal hospital room and
surrounded by a lot of fuss and strangers, being poked and prodded and
given a lot of treatment that only makes them uncomfortable and can't
hope to do more than give them a few more days of distress.

We went for palliative care only in those last months for my MIL, and
that included no treatment of any illness she could have developed
beyond comfort measures (i.e. if she'd gotten cancer, or pneumonia or
a heart attack, we would not have allowed them to start messing around
with her).

Mary G.